JP2005532869A - Nose and throat cleaning system and cleaning method - Google Patents

Abstract

At least one surgical system for the nose and sinuses and throat of the head, and a surgical method thereof. In the system and method of the present invention, an ablation accessory is used for the tissue on which surgery is performed. At the same time as the operation with the resection accessory, cleaning fluid is released from the resection accessory to the tissue. In addition, the excision accessory is provided with a path through which the discharged cleaning liquid is drawn back from the surgical site. Surgery is facilitated by the cleaning fluid released to the surgical site. In addition, this cleaning liquid is used to remove debris from the distal end of an endoscope for observing surgery, and is also used as a transport medium for applying a drug to a local surgical site.

Description

  This application claims priority from US Patent Application No. 60 / 395,881 filed on Jul. 13, 2002, under Section 119 of the U.S. Patent No. Surgical systems and methods designed for laryngeal or tracheal tissue surgery. More specifically, this application relates to a nasal and throat cleaning system and cleaning method designed to perform such tissue surgery and clean the surgical site.

  The purpose of various surgical treatments is to remove and / or shape the tissue at the surgical site. Surgery of the nose and sinuses and / or throat often involves excision of such tissue. For example, nasal surgery involves removing deformed cavity tissue or bone material of the cavity layer, sometimes referred to as the affected membrane and / or bone wall and / or cavity back layer. There is also often a need to selectively remove and / or shape hard or soft tissue that is part of the nasal surgery system for nasal shaping procedures and cosmetic surgery.

  A number of surgical instruments have been developed to facilitate such surgery. For example, the assignee manufactures a surgical instrument called HUMMER ™ that is particularly suitable for surgery on the nose, nasal cavity and throat. This surgical instrument includes a handpiece with an electrically driven motor. Various cutting accessories that are attached to the handpiece have been designed. Each ablation accessory typically includes a hollow rotational or reciprocating axis within a fixed tubular housing. The irrigation solution flows through the annular space between the axis of motion and the outer housing from the distal end of the ablation accessory, ie the end applied to the surgical site. Then all or almost all of this fluid is withdrawn from the distal end of the outer housing before it is released from the ablation accessory by suction through a rotating or vibrating shaft. This liquid serves as a transport medium for cleaning debris from the patient.

  Unfortunately, there are several disadvantages to conventional surgical methods for the nose, sinuses and throat tissue. One of these disadvantages is that it is sometimes difficult to cleanly remove tissue from the surgical site. This also means that tissue is drawn into the resection accessory due to the suction force on the surgical site. Furthermore, the tissue edge is likely to be pinched by the resection accessory. This causes even the most trained surgeon to remove more tissue than necessary from the surgical site. This excessive removal of tissue causes undesirable results. For example, during nasal surgery, this pinching can result in the removal of most of the nasal membrane as well as the target site from the surgical site. This unnecessarily exposes bone. When this nasal tissue is removed, the human body creates a new tissue lining. As the human body creates this new tissue, complete cure will be delayed and the burden on the patient will increase. Furthermore, the new organization is not as effective as the exchanged organization.

  Furthermore, the difficulties of conventional (nose and throat) surgical techniques lie with endoscopes often used during surgery. An endoscope is an elongated tube directed at a surgical site that can transmit light from and to the surgical site. When the surgical site is not within reach of the patient or difficult to observe, the surgeon uses the endoscope to observe the site. The advantage of performing surgery using an endoscope is that the patient's body must be opened to gain access to the surgical site, but to a lesser extent. Because the patient's body opening is minimized, the body is less infected and less likely to be cured after surgery.

  Various problems may arise when otolaryngological surgery is performed with an endoscope. This is because an opaque individual or opaque liquid that appears at the surgical site as a result of the surgical treatment adheres to the distal end of the endoscope. This material interferes with the visibility of the surgical site. Currently there are two ways to remove such substances. One is to remove the endoscope from the surgical site and wipe off the material that obstructs the field of view. This removes the endoscope, wipes out the disturbing material, and repositions it at the surgical site again. Furthermore, at that time, the antifogging substance applied to the endoscope is removed together with the obstacle. This antifogging material must be reapplied. Since such a step is required every time an obstacle occurs in the endoscope, the total operation time is extended. This is contrary to the modern surgical goal of performing surgery quickly to make the patient's anesthetic state as short as possible.

  A second obstacle removal method is to use a fluid spray device to some sort of surgical site. Such a device sometimes becomes a single unit. If this device is used, it must be placed in the immediate vicinity of the surgical site. Accordingly, this increases the number of devices placed at the surgical site. Alternatively, the fluid supply device is a sheath tube on which an endoscope is seated. A space between the inner wall of the sheath tube and the endoscope serves as a fluid path through which fluid is carried. The disadvantage of this device is that the overall diameter of the distal end portion of the inserted endoscope is quite large. Due to this increase in size, the difficulty level for properly inserting the endoscope and the difficulty level for operating the endoscope also increase.

  One technique that can be used to minimize problems associated with ENTs, including such sinuses, is to flood the surgical site with a cleaning solution. When another operation, for example, an endoscopic plastic surgery (sometimes referred to as arthroscopic surgery) is performed, the cleaning fluid is stored, and debris adhering to the distal end of the endoscope is continuously removed.

  However, when performing arthroscopic surgery, fluid is introduced into the substantially closed capsule of the rim. The nose, sinuses and throat are different. A passage integral to such an organ leads to the lungs. Thus, flooding such organs can cause fluids to flow out to other organs that are not intended to receive large amounts of fluids, particularly when the patient is under anesthesia.

  Therefore, when the nasal sinuses, sinuses and throat are overflowed with fluid prior to actual surgery, care must be taken not to allow the washing solution to flow out into the organ. The extra effort and attention required to immerse the nose and throat passages in the wash solution to perform surgery on nearby tissues is not a normal practice of ENT surgery.

The present invention is an ablation accessory configured to attach to a power-driven surgical handpiece, the ablation accessory comprising an outer hub, the surface shape of the outer hub being such that a coupling assembly attaches the outer hub to the handpiece. The outer hub is provided with a plurality of parts, one part of which is a reservoir, which is molded to engage with an integrated coupling assembly on the surgical handpiece. A through-bore extending to the front, the housing provided in front of the reservoir, the outer hub further extending from the outer surface to the through-bore side and between the reservoir and the housing In an ablation accessory, the outer housing is formed as a through-bore housing for the outer hub. The outer housing part is provided in the through-bore so that the proximal end of the outer housing part is located in front of the inlet bore, and at least a part of the outer housing is disposed in the vicinity of the through-bore of the outer hub An inner hub is provided, the distal end of the inner hub being disposed within a through bore reservoir of the outer hub, which facilitates the inner hub and the motor in the surgical handpiece. The inner hub is provided with a through-bore, and a rotary shaft extending forward from the inner hub through the through-bore of the outer hub is provided. Sitting on the through-bore of the inner hub,
An expandable O-ring fitted into the rotating shaft is provided near the far end of the inner hub so as to be positioned in the storage portion of the through-bore of the outer hub, and the inner diameter of the O-ring is the rotating shaft when not extending. The outer diameter is smaller than the outer diameter of the outer hub, and in the extended state, the outer diameter is larger than the diameter of the storage portion of the through-bore of the outer hub.

  The systems and methods of the present invention provide numerous advantages in increasing the efficiency of nasal passages, nasal cavities, and throat surgeries made in the nasal lining. In the method of the present invention, the lavage fluid can be released to the surgical site while using the resection accessory for tissue removal. As a result, it is possible to easily remove tissue quickly while reducing the extent to which excess tissue is removed. When using an ablation accessory for tissue removal, the system and method provide a simple means for the surgeon to quickly determine whether the ablation accessory has become partially clogged. The systems and methods of the present invention also provide a means for the surgeon to clean the endoscope 32 used for surgery without having to pull the endoscope out of the surgical site or introduce additional instruments into a narrow surgical area. It is to provide.

  The present invention relates to new and useful systems and methods for performing ENT surgery, such as sinus tissue. In the system and method of the present invention, a surgical instrument designed to release the cleaning solution from the opening of the instrument in a specific spray pattern is used. Thus, in the system and method of the present invention, the irrigation solution can be utilized to perform functions beyond simply functioning as a fluid that flows through the carrier of unwanted material and the surgical instrument. In particular, in order to remove substances that adhere to the endoscope and obstruct the field of view of the endoscope, it can be sprayed to the distal end side of the endoscope. This spraying can be used to wet the surgical site and facilitate removal of material from the surgical site. Furthermore, the system is also designed to apply drug sprays and other fluids useful for surgery directly to or near the surgical site.

  The invention is explained in detail in the claims. The above-described features and advantages of the present invention can be better understood with reference to the following description in conjunction with the drawings.

  FIG. 1 illustrates how the surgical system 20 of the present invention is used for surgery on the sinus of the patient's head 22. Surgical system 20 includes an electric handpiece 24 that drives an ablation accessory 26. The resection accessory 26 is inserted into the patient's nostril or throat 28 and placed against the tissue 30 (FIG. 9) at the surgical site where the surgical procedure is to be performed. The surgeon observes the surgical site with the endoscope 32. The endoscope 32 is an elongated device, and is inserted into a nostril, and is arranged so that the distal end of the endoscope is slightly away from the surgical site. ("Near" means the side of the surgeon or the side away from the surgical site.) ("Distant" means the side away from the surgeon or the side of the surgical site.) Inside the endoscope There is a medium for transmitting the light beam of the surgical site image to the vicinity end of the endoscope. This light beam is captured by the camera head 34 attached to the vicinity end of the endoscope. The video signal emitted by the camera head 34 is used to display a diagram of the surgical site on the monitor 36.

  A motor 38 (FIG. 8B) that drives the ablation accessory is provided in the handpiece 24. The power of the handpiece motor 38 is supplied by the control console 40. The control console 40 also supplies a cleaning solution from the supply container 42 to the cutting accessory 26. In particular, the control console 40 is provided with a pump 44 that pumps fluid supplied by gravity from a supply container 42 through a supply tube 46 connected to the cutting accessory 26. In one form of the invention, the supply tube 46 communicates with a path in the handpiece 24.

  2 and 3 show the basic components of the cutting accessory 26 used in the present invention. The ablation accessory 26 includes a tubular outer housing 50. In the case of a special cutting accessory, such as a shaver, it is constructed such that the distal end of the outer housing 50 is closed. A small housing window 52 is formed in the vicinity of the closed distal tip of the outer housing 50. The outer hub 54 is best shown in FIGS. 4A and 4B, which is secured to the proximal end of the outer housing 50. The outer hub 54 is a substantially tubular member that extends rearward slightly beyond the proximal end of the outer housing 50. The outer hub 54 is formed to have a set of spaced apart generally L-shaped teeth 56. The teeth 56 are formed with a lock slot 58 between the teeth. When the resection accessory 26 is inserted into the open distal end of the handpiece 24, a locking member that is integral with the coupling assembly in the handpiece will seat in the locking slot 58. Thanks to the shape of the teeth 56 and the locking slot 58, the outer hub 54 and thus the cutting accessory 26 are retained on the handpiece 24 when the locking member is seated in the slot.

  On the far side of the teeth 56, the outer hub 54 is formed with two spaced grooves 62 on its outer surface. The groove 62 is formed so as to accommodate the O-ring 64. On the outer surface between the grooves 62, the outer hub 54 is further formed to have a relatively shallow concave groove 66. The widthwise bore 68 extends from the bottom surface of the groove 66 on the outer hub to the bore side of the hub central axis located below.

  On the far side of the portion of the outer hub 54 where the farthest groove 62 is formed, the outer hub 54 is formed with a set of spaced webs 70. The outward outer peripheral flange 72 intersects the web 70. The web 70 contacts and terminates in the vicinity of a flat ring 74 that extends around the outer periphery of the outer hub 54. A web 76 that is aligned with the web 70 extends forward from the distal end of the flat ring 74 to the distal end of the outer hub 54. The contour of the web 76 is triangular, i.e., the largest width at a site that begins to extend forward from the flat ring 74 away from the central axis of the outer hub 54. Web 70, flange 72, flat ring 44, and web 76 structurally strengthen outer hub 54. Also, the web 76 makes the outer hub 54 forming process easier.

  When the cutting accessory 26 is assembled, the outer housing 50 and the outer hub 54 are joined together so that the longitudinal axis of the housing window 52 is aligned with one of the webs 76. Using a coupling assembly to hold the ablation accessory 26 to the handpiece 24 will selectively set the direction of rotation of the outer hub 54 relative to the handpiece. This means that the outer hub 54 can be set to select the direction of rotation relative to the handpiece of the housing window 52 of the outer housing. The positioning of the housing window 52 with respect to one of the outer hub webs 76 facilitates the determination of the position of the medical operator's window and can be set to the desired orientation.

  Further, the outer hub 54 is formed with a coaxial bore centered about a number of hub longitudinal axes therein. The housing bore 80 extends from the distal end of the outer hub 54 to the site surrounded by the furthest groove 62. The housing bore 80 is a portion of the outer hub 54 on which the proximal end of the outer housing 50 is seated. The inlet bore 82 extends from the housing bore 80 to the proximal side. The diameter of the inlet bore 82 is wider than the housing bore 80. The inlet bore 82 is surrounded by a groove 66 in the outer hub. As shown in FIG. 3, the widthwise bore 68 opens to the inlet bore 82 side. The storage bore 84 extends from the vicinity of the inlet bore 82. The diameter of the storage bore 84 is larger than the diameter of the inlet bore 82. The counterbore 86 extends away from the storage bore 84 to the proximal end of the outer hub 54. The diameter of the counter bore 86 is larger than the diameter of the storage bore 84. The outer hub 54 is formed to have a short taper 88 on the inner wall. This tapered portion 88 constitutes a transition between the storage bore 84 and the counter bore 86.

  A tubular rotating shaft 90 is disposed in the outer housing 50. The far end of the rotating shaft 90 is closed. The rotating shaft 90 is formed to have a rotating shaft window 93 extending from the far end to the vicinity. The rotation axis window 93 is defined by the end surface 94 of the rotation axis 90. Similarly, the housing window 52 of the outer housing 50 is defined by a sharp beveled edge 53 of the outer housing. Therefore, the ends 53 and 94 function as a hook when the rotating shaft 90 rotates.

  In a preferred embodiment of the present invention, the outer housing 50 and the rotating shaft 90 are formed such that the housing window 52 is smaller than the rotating shaft window 93. For example, as one form of this invention, the outer diameter of the outer housing 50 is 4.0 millimeters. In this form of the invention, the length of the longitudinal axis of the housing window 52 of the outer housing is 0.209 inches (about 0.531 centimeters). In this form of the invention, the length of the longitudinal axis of the rotation axis window 93 is 0.233 inches (about 0.592 centimeters). In another form of the invention, the outer diameter of the outer housing 50 is 3.5 millimeters. In this form of the invention, the length of the longitudinal axis of the housing window 52 is 0.175 inches (about 0.445 centimeters). The length of the rotary window 93 of the rotary shaft 90 is 0.208 inches (about 0.528 cm). In yet another form of the invention, the outer diameter of the outer housing 50 is 2.5 millimeters. In this form of the invention, the length of the outer housing window 52 is 0.082 inches (about 0.208 centimeters). The rotation window 93 of the rotation axis 90 of the ablation accessory 26 has a length measured along the longitudinal axis of the rotation axis window 93 of 0.140 inches (about 0.356 centimeters).

  As shown in FIGS. 5 and 6, it is further understood that the opposite surface of the rotation shaft window 93 is formed to be a flat surface 98 at the far end of the rotation shaft 90. The rotary shaft 90 is configured such that the flat surface 98 extends from the immediate vicinity of the portion where the material constituting the rotary shaft begins to bend beyond the longitudinal axis to the vicinity of the space surrounded by the rotary shaft window 93. . The rotation shaft opening 102 extends from the flat surface 98 to the central space side of the rotation shaft 90. The rotation shaft opening 102 is disposed so as to be aligned with the rotation shaft window 93. The size of the rotation shaft opening 102 is smaller than that of the rotation shaft window 93. The content of US Pat. No. 6,342,061 (SURGICAL TOOL WITH INTEGRATED CHANNEL FOR IRRIGATION) of the assignee of the application granted on January 29, 2002 is described in the specification. Thus, it is described whether the distal end of the resection accessory is constructed.

  The rotation shaft 90 extends through the outer hub 54. The inner hub 104 is fitted to the end of the rotating shaft 90 that enters the vicinity side beyond the inner hub 104. As shown in FIGS. 7A and 7B, the inner hub 104 includes a coaxial bore 106 extending from its distal end to the proximal side. The vicinity end of the rotating shaft 90 is fixed to the bore 106. A counterbore 108 having a larger diameter than the bore 106 extends from the proximal end of the bore 106 to the proximal end of the inner hub 104.

  Inner hub 104 is formed with a relatively small diameter leg 110 at the proximal end. The vicinity end of the leg part 110 is tapered. Further, the leg portion 110 is formed so as to have a groove 112 on the far side of the vicinity end thereof. The O-ring 114 (FIG. 3) is seated in the groove 112. The inner hub body 116 is located on the far side from the leg portion 110 and has an outer diameter larger than that of the leg portion 110. The teeth 118 extend from the inner hub body 116 to the vicinity side so as to cover the legs 110. Inner hub teeth 118 engage complementary teeth connected to the drive shaft of the handpiece motor. The spring 119 is disposed around the tooth 118. When the cutting accessory 26 is attached to the handpiece 24, the distal end of the spring is seated on the surface of the motor drive shaft. The spring 119 urges the inner hub 104 and the rotating shaft 90 forward to meet manufacturing tolerances.

  The inner hub 104 is further formed to have a ring-shaped flange 120 that projects outwardly just away from the inner hub body 116. A neck portion 122 is located on the far side from the flange 120. Inner hub 104 is dimensioned slightly spaced inwardly from outer hub counterbore 86 so that its neck 122 is free to rotate within outer hub counterbore 86. The inner hub 104 is formed to have a head 124 with a smaller diameter than the neck 122 extending away from the neck 122. The diameter of the head 124 is such that it is slightly spaced inward from the outer periphery of the storage hub 84 of the outer hub. Further, the inner hub 104 is formed to have a small beveled edge 126 around the outer periphery of the distal end of the head 124.

  Before inserting the rotating shaft 90 into the outer housing 50, the O-ring 130 (FIG. 3) is fitted on the rotating shaft 90. The O-ring 130 is positioned against the distal surface of the inner hub head 124. More specifically, the component of the present invention is dimensioned such that the inner diameter of the unexpanded O-ring is slightly smaller than the outer diameter of the rotating shaft 90. In general, according to one embodiment of the present invention, the inner diameter of the O-ring 130 is 0.002 to 0.005 inches (about 0.005 to 0.013 centimeters). The difference is about 0.003 inches. The outer hub 54 is formed so that the diameter of the storage bore 84 (which is a space in which the O-ring is seated) is smaller than the outer diameter of the O-ring when the O-ring is attached to the shaft and expanded. Is done. Typically, these components have an outer diameter of 0.007 to 0.010 inches (about 0.01778 to 0.0254 centimeters) with the O-ring 130 attached to the shaft and unfolded. Thus, it is selected to be larger than the storage bore 84. When the rotary shaft / inner hub assembly is inserted into the outer housing / outer hub assembly, the O-ring 130 becomes a static seal around the rotary shaft 90.

  Further, the outer hub storage bore 84 and counter bore 86, the inner hub neck 122 and head 124, and the O-ring 130 are O-rings when the distal end of the inner hub 104 is inserted into the proximal end of the outer hub 54. And a dimension that allows a little free space between the bottom surface of the storage bore 84 located far away. Even if the O-ring 130 enters far away, the O-ring comes into contact with the stepped portion between the storage bore 84 and the inlet bore 82, so that this movement eventually stops.

  In this form of the invention for ENT surgery, the maximum outer diameter of outer housing 50 is typically 5.0 millimeters or less. In another form of the invention for ENT surgery, such as sinus surgery, the maximum outer diameter of the outer housing 50 is 4.5 millimeters or less. In a more preferred form of the invention, the maximum outer diameter of the outer housing 50 is 4.0 millimeters or less. Occasionally, sinus or ENT surgery is performed using a resection accessory fitted with an outer housing 50 having an outer diameter of 3.5 millimeters or less. In one form of the invention, outer housing 50 has an outer diameter of 0.1345 inches (3.4163 millimeters) and an inner diameter of 0.1125 inches (2.8575 millimeters). The outer diameter of the complementary rotating shaft 90 is 0.099 inches (2.5146 millimeters). In general, to provide a sufficient flow of cleaning fluid to the distal end of the ablation accessory, the minimum separation between the inner wall of the outer housing 50 and the outer wall of the rotating shaft 90 is at least 0.0005 inches (0.0127 millimeters). is necessary. The flat surface 98 is formed to have a depth of up to 50% of the thickness of the wall of the rotating shaft 90. The far end of the rotation shaft of the rotation shaft window 93, the rotation shaft opening 102, and most of the flat surface 98 may be a component different from the vicinity of the rotation shaft 90.

  The structure of one handpiece 24 designed to drive the ablation accessory 26 is shown in FIGS. 8A, 8B, 8C. The handpiece 24 has an elongated handpiece body 134 that houses a motor 38. The front end of the handpiece body 134 is formed with an opening 135 that accommodates substantially all of the outer hub 54 and all of the inner hub 104. The motor 38 has a fluid tubular motor shaft 136 through which fluid flows to or from the central portion of the rotating shaft 90. The suction attachment portion 138 extends from the vicinity of the handpiece main body 134. The suction attachment portion 138 is in fluid communication with the rotating shaft 90 and the motor shaft 136 coaxially. The suction pump 137 (FIG. 1) passes through the suction line 139 and is sucked through the suction attachment portion 138. A method for assembling a handpiece having such a structure is disclosed in assignee's US Pat. No. 6,152,941 (ENDOSCOPIC CANNULTED HANDPICTURE MOTOR WITH INTEGRATED SUCTION CONTROL) granted on Nov. 28, 2000, The present disclosure is described herein.

  The cleaning liquid is introduced into the handpiece 24 through the inlet mounting portion 140 at the vicinity of the handpiece body 134. The handpiece body 134 is formed to have a set of cleaning fluid paths (generally indicated by reference numeral 142 extending from the inlet fitting 140 to the distal end side of the handpiece body 134). The farthest end of the fluid path 142 extends to a discharge opening 144 formed on the inner wall of the handpiece body that forms the opening 135. When the cutting accessory 26 is seated in the opening 135 of the handpiece body 134, the discharge opening 144 is aligned with the groove 66.

  The valve 146 is rotatably attached to a valve bore 148 formed in the handpiece body between the tubular motor shaft 136 and the suction attachment portion 138. A branch of fluid path 142 extends to valve bore 148. The valve 146 is selectively disposed by a slide switch 147. Valve 146 is selectively positioned to cause the tubular motor shaft and rotor shaft to communicate with the suction attachment or to cause the rotor shaft to be in fluid communication with a fluid path 142 that introduces cleaning fluid into handpiece 24. How this valve 146 is selectively positioned is described in the assignee's US patent application Ser. No. 09 / 302,148, filed Apr. 29, 1999 (POWERED SURGICAL HANDPICTURE WITH INTEGRATED IRRIGATOR AND SUCTION APPLICATION. ) (Currently U.S. Pat. No. __) and U.S. Patent Application No. 10 / 251,646 (SURGICAL TOOL SYSTEM) (currently U.S. Pat. No. __) filed on Sep. 21, 2002. Although disclosed, this disclosure is described herein. This fluid flow through the rotating shaft 90 may be referred to as a purge flow. This flow removes debris trapped in the rotating shaft 90.

  The pump 44 used to supply the cleaning fluid to the handpiece may be a TPS ™ cleaning control pump from Assignee (Striker Corporation, Kalamazoo, Michigan). This special pump can supply as much as 22-41 milliliters of cleaning liquid per minute to the handpiece at a pressure of 16 psi (110.4 kPa). In a preferred embodiment of the invention, the pump 44 is set to supply more than 25 milliliters of cleaning solution per minute, and in a more preferred form, it is set to supply more than 30 milliliters of cleaning solution per minute. Yes.

  The surgical system 20 of the present invention is used to perform endoscopic surgery such as sinus surgery shown in FIG. When performing this operation using this system, the endoscope 32 is arranged in the vicinity of the surgical site so that the surgeon can recognize the surgical site. In order to perform the necessary surgery, a resection accessory 26 is placed at the surgical site. Typically, in surgery, the rotating shaft 90 is driven to remove or shape the patient's tissue with the ablation accessory 26. The surgical system 20 of the present invention is used for surgery in a “dry” environment where the surgical site is not immersed in a cleaning solution. Such an environment is the nasal passage where the system is placed for performing sinus surgery.

  The pump 44 pumps the cleaning solution to the distal end of the ablation accessory 26. Specifically, fluid flows through a supply line 46 that extends from the pump outlet to the handpiece inlet fitting 140. This fluid passes through the fluid path 142 and is discharged from the discharge opening 144 of the handpiece. If the outer hub width bore 68 is aligned with the handpiece discharge opening 144, the cleaning fluid is discharged directly into the width bore 68. However, if the outer hub widthwise bore 68 is not aligned with the handpiece discharge opening 144, fluid will flow through the groove 66. The O-ring 64 of the outer hub functions as a seal for fluid flowing outside the space between the O-rings. In a fairly short time, back pressure pumps fluid from outer hub width bore 68 to groove 66.

  The cleaning liquid flows from the widthwise bore 68 through the inlet bore 82 and the storage bore 84 in the outer hub 54. The O-ring 130 functions as a static seal around the rotating shaft 90. The O-ring 130 functions so that the cleaning liquid introduced from the widthwise bore 68 does not flow out to the vicinity side beyond the storage bore. As a result, stored fluid accumulates in both inlet bore 82 and reservoir bore 84. Then, due to the pressure, all or almost all of the fluid introduced into the outer hub 54 is pumped downstream of the cutting accessory 26 on the far end side. The fluid flows in an annular space between the inner wall of the outer housing 50 and the outer wall of the rotating shaft 90. It should be understood that there is a relatively wide separation between these two surfaces in the vicinity of the flat surface 98 of the axis of rotation. The gap between these two surfaces functions as a reservoir that holds the cleaning liquid.

  As a result, fluid flows to the distal end of the outer housing 50 of the ablation accessory. Intake through the rotating shaft 90 is drawn through the rotating shaft window 93 and the rotating shaft opening 102. By this suction, the fluid flows through the rotating shaft 90 and the handpiece 24 to the vicinity side. When the cleaning liquid flows through these components, it functions as a transport medium that pumps debris from within the rotating shaft 90 to the collection container of the suction pump.

  The system used to perform the surgery is shown in FIG. As shown therein, in order to use the ablation accessory 26 for tissue removal, the ablation accessory is positioned to press the outer housing window 52 against the tissue. The handpiece motor 38 is driven to rotate the rotating shaft 90, thereby excising the tissue. The ablated tissue is aspirated through the ablation accessory 26 and handpiece 24 as previously described. As can be seen, the distal end of the endoscope 32 is located in the vicinity of the surgical site where the resection accessory is applied so that the surgeon can recognize the surgery.

  When performing the surgical method of the present invention, the ablation accessory performs four functions simultaneously. First, as a result of the rotation of the rotating shaft 90, the resection accessory 26 functions as a resection unit that removes tissue such as the sinus lining layer.

  Second, wash fluid is released into the tissue to be excised. One path through the ablation accessory 26 through which fluid is released is shown in FIG. As shown there, the fluid under pressure (indicated by arrow 155) flows through the arcuate gap between the rotating shaft 90 and the outer housing 50 and is discharged out of the housing window 52. Part of this discharge is due to the hub O-ring 130. The O-ring 130 completely or almost completely blocks the cleaning liquid from flowing to the vicinity when the fluid flows into the outer housing 50 through the widthwise bore 68 of the outer hub. More specifically, in one form of the invention, the O-ring 130 provides a sufficient seal so that 90% or more of the cleaning fluid introduced into the width bore 68 flows to the distal end of the ablation accessory 26. In a more preferred form of the invention, the O-ring 130 provides a sufficient seal so that 95% or more of the cleaning liquid introduced into the width bore 68 flows to the distal end of the ablation accessory 26.

  Further, when the rotary shaft 90 is seated in the outer housing 50, as shown in FIG. 13, the distal end of the rotary shaft contacts the vicinity of the inner wall of the outer housing. The result is a small circular shield inside the outer housing just above the distal end of the axis of rotation. This shielding suppresses the flow of the cleaning liquid. As a result, when the fluid approaches the far end of the outer housing 50, it will experience significant pressure. The cleaning liquid is discharged from the inner side of the outer housing 50 to the outer side through the housing window 52 and along the traveling path to the proximal end side of the cutting accessory at an angle deviated from the longitudinal axis of the cutting accessory.

  This fluid acts as a lubrication between the tissue and the end face of the outer housing / rotary shaft. Since the friction of the tissue moving to the metal surface of the ablation accessory is reduced, the degree of pinching between the outer housing and the rotating shaft is reduced. Accordingly, a relatively clean and sharp tissue (sinus sinus lining layer 151 in FIG. 10) can be excised. This sharp ablation reduces tissue pinching (retraction) from the outer housing 50 window into the ablation accessory. And since this pinching is reduced, the extent to which the surgical site that the surgeon wants to leave is mistakenly removed is also reduced. Thus, when performing sinus surgery using the method of the present invention, the degree of erroneous excision of tissue that must remain at the surgical site is also reduced. In this sinus surgery, it is ensured that the sinus lining layer 151 is not removed to the extent that the underlying bone 153 is exposed.

  At the same time, the third function of the excision accessory having the previous two functions is to draw the cleaning solution released to the surgical site from the surgical site. This fluid flow is indicated by arrow 157 in FIG. This movement is due to the suction of the surgical site through the far end window of the rotating shaft. This aspiration minimizes the amount of irrigation fluid released to the surgical site. If this fluid is not collected, surgery on the surgical site becomes complicated.

  A fourth function of the ablation accessory 26 is the circulation of cleaning fluid through the ablation accessory so that it functions as a transport medium for debris drawn into the rotating shaft. This function is illustrated by arrow 159 in FIG. 13 and shows fluid flow through the rotary shaft opening 102 from between the outer housing 50 and the rotary shaft 90 so that fluid flow occurs below the rotary shaft. Yes.

  The release of cleaning fluid by the ablation accessory when the ablation accessory is used for surgery has yet another advantage. In particular, the surgical system of the present invention supplies a relatively large amount of fluid to the distal end of the ablation accessory. Almost all the fluid is normally drawn back to the vicinity through the rotating shaft 90. As a result, the fluid constitutes a relatively strong pressure head. This pressure head is useful for pumping debris in the downstream ablation accessory that can obstruct the suction flow.

  However, debris in the ablation accessory or handpiece can partially but not completely obstruct the suction flow. If this happens, the cleaning solution will begin to accumulate near the surgical site. The surgeon immediately notices that this retention has occurred and can be interpreted as causing partial clogging of the resection accessory 26. Upon recognizing such a condition, the surgeon will withdraw the ablation accessory in order to remove the clogging or insert an unclogging ablation accessory. Thus, the method according to the present invention provides a means for the surgeon to quickly determine if the ablation accessory is partially clogged and that such clogging will reduce the overall efficiency of the operation.

  Furthermore, as a result of the surgical procedure, debris may hit the distal end of the endoscope 32 and adhere. This debris often interferes with the surgeon's view of the surgical site. In the surgical system of the present invention, debris is removed from the endoscope by placing a resection accessory and endoscope as shown in FIG. In particular, the ablation accessory 26 is rotated so that the housing window 52 is away from the tissue. The distal end of the endoscope 32 is positioned relatively near the housing window 52. In some preferred implementations, the housing window 52 is at most 5.0 centimeters apart, and in other embodiments of the invention, the housing window 52 is at most 3.0 centimeters apart. In the preferred form of the invention, this spacing is a maximum of 2.0 centimeters from the housing window 52. In yet another preferred form of the invention, this spacing is a maximum of 0.5 centimeters from the housing window 52. When the ablation accessory 26 is so positioned, fluid is pulsed out of the housing window as a spray. In the drawing, this fluid pulse is shown as a droplet 160. Due to the arrangement of the components, some of the droplets will bounce off the distal end of the endoscope 32 and wash away debris adhering to the endoscope. When the debris is removed, the endoscope 32 becomes clean and there is nothing that obstructs the field of view.

  Two mechanisms that appear to cause a pulsatile release of irrigation fluid from the ablation accessory 26 are shown in FIGS. Initially, one reason for the pulsating flow is that all or nearly all of the cleaning liquid introduced into the outer hub width bore 68 flows downstream. Only a small amount of cleaning liquid leaks beyond the O-ring 130 to the far side. As a result, fluid that reaches the distal end of the outer housing experiences a relatively high amount of pressure. To produce such pressure, pump 44 pumps fluid through handpiece 24 and ablation accessory 26 at a pressure of 7-32 psi (48.3-220.8 kilopascals) at a flow rate of 25-112 milliliters per minute. Operates as follows. Of course, it should be understood that the actual fluid pressure will also depend on the speed of the pump 44, which is normally set by the surgeon.

  It should be understood that the minimum flow rate at which the cleaning liquid is supplied to the pump depends on the suction by the suction pump 137. In general, the higher the suction rate, the higher the cleaning liquid supply rate to the resection accessory 26. For example, in the case of a relatively low suction force (3 inch hectogram), in order to obtain a preferred pulse release from the housing window 52, the cleaning solution is excised at a minimum flow rate of 25 ml / min, more preferably 30 ml / min or more. Supplied to accessories. When the suction force from the surgical site by the suction pump 137 is 14 inches of hectogram, in order to carry out the present invention, the washing liquid flows out to the ablation accessory at a minimum supply rate of 40 ml / min, more preferably 60 ml / min. Must. In general, the expected maximum flow rate of cleaning fluid to the ablation accessory is 90-120 milliliters per minute. Typically, the lavage fluid flows out to the ablation accessory at about 16 psi (110.4 kilopascals).

  FIG. 13 shows an example in which an ablation accessory according to the present invention emits pulsed fluid. Specifically, as shown in FIG. 13, the rotating shaft 90 and the flat surface 98 are aligned with the housing window 52. A relatively large volume of fluid is located just above the flat surface 98. Since this fluid is under pressure, when this amount of fluid is exposed to the housing window 52, it is released from the housing window 52 as indicated by arrow 162.

  In FIG. 13, an arrow 162 indicates a fluid flow returning to the near side to the end side of the cutting accessory 26 connected to the handpiece 24. The fluid flows in this direction because the cleaning liquid held on the flat surface 98 is subjected to high pressure before the flat surface 98 is aligned with the housing window 52. When the flat surface 98 is aligned with the housing window 52 for the first time, the cleaning liquid at the far end of the flat surface is in a high pressure state, and thus forms a barrier that prevents the upstream fluid from flowing to the far side for a while. This barrier constitutes a surface, as indicated by a dotted line 163, from which the upstream fluid is reflected and guided to the far side. This barrier appears to occur even when a small amount of fluid is drawn into the rotating shaft 90 from the rotating shaft opening 102.

It should be understood that the spraying of the cleaning liquid is not guided only to the vicinity. This solution is also diffused into the arcuate area above the ablation accessory 26. This arch spraying occurs because the flat surface 98 of the rotating shaft rotates across the entire housing window 52 when the cleaning liquid is discharged. As a result, fluid is discharged from the housing window 52 at the inertial angle of the rotating shaft 90. It will be appreciated that this emission is pulse shaped. Collectively, the pulsed release will be 50% or more of the volume of cleaning fluid released from the ablation accessory 26.

  Further, as shown in FIG. 14, when the rotation axis window 93 is aligned with the housing window 52, the fluid seems to be rhythmically sent from the cutting accessory 26. Again, if the fluid is exposed to the outside environment through the rotating shaft opening 102, the rotating shaft window 93, and the housing window 52 due to the fluid pressure of the exposed flat surface 98, these openings are shown as indicated by arrows 164. Quickly released through

  As a result of the sealing by the O-ring 130, the fluid supplied to the ablation accessory will be released from the housing window 52 at an appropriate rate before being drawn back to the ablation accessory side by the suction pump 137. Depending on the rate at which the surgical system 20 is actually driven, more than 6% of the fluid introduced into the ablation accessory 26 is released from the housing window 52. In a preferred form of the invention, more than 8% of the cleaning solution is so released, and in another form of the invention, more than 10%, or more than 16% of the fluid is so released. More specifically, when cleaning fluid is introduced into the ablation accessory at a flow rate of 25 milliliters per minute, the cleaning fluid is discharged from the housing window at a flow rate of 2 milliliters or more, and often 4 milliliters or more. When irrigation fluid is introduced into the ablation accessory 26 at a flow rate of 40-60 milliliters per minute, the fluid flows from the housing window 52 at a flow rate of 4 milliliters per minute, and in a more preferred form of the invention, 10 milliliters per minute or more. Is released at a flow rate of. Typically, the maximum flow rate at which the irrigation fluid should be released when performing ENT or sinus surgery is 15 milliliters per minute.

  The systems and methods of the present invention provide numerous advantages in increasing the efficiency of nasal passages, nasal cavities, and throat surgeries made in the nasal lining. In the method of the present invention, the lavage fluid can be released to the surgical site while using the resection accessory for tissue removal. As a result, it is possible to easily remove tissue quickly while reducing the extent to which excess tissue is removed. When using an ablation accessory for tissue removal, the system and method provide a simple means for the surgeon to quickly determine whether the ablation accessory has become partially clogged. The systems and methods of the present invention also provide a means for the surgeon to clean the endoscope 32 used for surgery without having to pull the endoscope out of the surgical site or introduce additional instruments into a narrow surgical area. It is to provide.

  In addition, another feature of the system and method of the present invention is that a relatively small amount of cleaning liquid is required to pump the cleaning liquid to the ablation accessory 26 in order to pulse out the housing window 52. This ensures that the O-ring 130 ensures that all or nearly all of the cleaning fluid introduced into the widthwise bore 68 of the outer hub will flow to the far side and that the fluid will not be drawn to the near side by the suction force returning to the handpiece side. It is to make it. As a result, for low suction forces (3 inch hectograms), it is usually necessary to flush the cleaning liquid through the pump at a relatively low flow rate (25 milliliters per minute) before the cleaning liquid is discharged from the housing window 52. . Since irrigation fluid is introduced into the ablation accessory 26 at a relatively low flow rate, and in practice, up to 20%, typically less than 17%, and sometimes less than 15% of irrigation fluid is released from the housing window 52 to the surgical site, so a small amount Only the cleaning liquid is thus released.

  The relatively low volume of irrigation fluid discharge helps to minimize immersion in the human body path to which the surgical instrument of the present invention is applied and adverse consequences to the patient. It will be understood that all or most of this cleaning liquid discharge is pulled back to the handpiece by suction applied to the rotating shaft 90. Therefore, the system and method of the present invention introduces a large amount of cleaning liquid into the passage filled with non-fluid so as to increase the surgical efficiency and not to pose a risk to the patient.

  The surgical system 20 of the present invention is also used to apply drugs and auxiliary compounds directly to a local surgical site. Such drugs and adjunct compounds administered to the surgical site include, but are not limited to, antibiotics, anti-inflammatory, antifungal compounds, and anesthetics. Another compound applied to the surgical site is a lubricant that facilitates tissue resection when applied to the surgical site, or a lubricant that reduces friction between debris and bone fragments and the components that make up the suction path. Contains agents. It is clear that complex compounds and drugs can be introduced simultaneously. As shown in FIG. 15, this form of the system includes a drug or auxiliary compound container 170 between the container 42 and the pump 44. The contents of the container 170 are pumped through the supply line to the pump 44 by the auxiliary pump 172. The auxiliary pump 172 may be any device that is convenient for supplying fluid to the supply line. For example, one form of the auxiliary pump 172 may be an electrically controlled plunger. The drug in the container 170 flows out to the housing on which the plunger is seated when the plunger is retracted. Then, the plunger is pressed into the housing in response to the drive signal, and a predetermined amount of medicine is pumped through the supply line to the pump 44. In these forms of the invention, the motorized valve 174 regulates the flow rate of fluid from the auxiliary pump 172 to the supply line. This prevents the drug from flowing downstream when drug application is not required.

  In this form of the invention, the drive of auxiliary pump 172 and valve 174 is regulated by an electrical circuit within control console 40. When drug application is required, valve 174 opens first. The auxiliary pump 172 is then driven to pump the downstream flow of the drug so that it mixes with the cleaning fluid supplied to the ablation accessory 26. The surgeon then dispenses the drug to the tissue in the same manner that the irrigation fluid is applied to the tissue using the resection accessory 26.

  It will be appreciated that the foregoing description is limited to a particular form of system or method for performing endoscopic surgery. Other forms of the invention can be different from those described above. For example, the specific structure of the handpiece 24 and the cutting accessory 26 can be different from those described above. Also, the exemplary ablation accessory 26 was a specific type of ablation accessory or shaver. However, the present invention can be practiced with other types of ablation accessories such as bars and rasps. Further, the inclined ends 53, 94 of the exemplary cutting accessory are straight, but in another form of the invention, they can be formed with teeth. Similarly, the cross-sectional shape of another alternative cutting accessory according to the present invention can be different from the circular cross-section cutting accessory described above. For example, in another form of the invention, these components are curved but not circular in cross-section. In yet another form of the invention, the component has a straight cross-sectional shape. For example, the cross-sectional shape of such a component is a polygonal shape, such as a quadrangle, pentagon or hexagon.

  It will be appreciated that conventional bar and rasp type cutting accessories include an outer housing having an open end. In some forms of these accessories designed for the present invention, it can be expected that the end of the outer housing is partially closed. A window larger than the housing window 52 facilitates access to the ablation head. As a result, the pressure volume of the cleaning liquid increases, and the fluid is discharged as a pulse from the outside of the window when the rotating shaft flat portion holding the fluid is aligned with the window.

  It will also be appreciated that in some forms of the invention, the rotational axis 90 of the ablation accessory 26 need not always be provided with the rotational axis opening 102. For example, it is not always necessary to provide a rotational axis opening according to one aspect of the present invention that allows the handpiece to direct a pulsed flow of cleaning fluid through the rotational axis 90 to the distal end of the ablation accessory.

  Similarly, the outer hub 54 and the inner hub 104 are merely examples, and the present invention is not limited thereto. In a form of the invention that uses an outer hub 54 and an inner hub 104, which are alternative coupling systems, various surface elements are provided to facilitate coupling of the complementary handpiece and the drive unit within the handpiece. It can also be said.

  Similarly, in another form of the invention, the shaft integrated with the ablation accessory may not rotate, but may reciprocate back and forth. Rasp is a type of ablation accessory with a reciprocating coaxial. Typically, a handpiece that drives an ablation accessory with a reciprocating type shaft includes a link assembly that can transmit the rotational motion of the motor shaft to the forward and backward motion and send it to the ablation accessory shaft. Alternatively, this link is included in an accessory attached to the distal end of the handpiece. In one form of the invention, the shaft is part of a link assembly with which the cutting head engages in repeated back and forth motion.

  Similarly, the shape of the components making up the present invention may be different from the description given above. For example, in one form of the invention, the distal ends of the housing and the ablation accessory rotation axis are formed with a smaller diameter than the more proximal portions of these components. It will also be appreciated that not all ablation accessories integrated with the present invention include a motor driven axis of rotation within a static housing. In another embodiment of the present invention, the ablation accessory may include a tissue processing member that emits high frequency energy, an ablation probe, a member that emits ultrasonic energy, and a member that emits optical energy such as coherent laser light. . In these forms of the invention, accessories that are actually applied to the surgical site include an elongated member that rocks the tip with the energy emitting device and a path through which energy generated by the handpiece is sent to the device. The accessory is configured to constitute a lumen through which the cleaning fluid is released to the surgical site. There is also a lumen through which suction is taken from the surgical site. In these forms of the invention, a single lumen or pathway can perform more than one of the above functions. In this way, using a single instrument, the surgeon can apply high frequency energy, ultrasonic energy, or light energy to the surgical site, as well as to clean the endoscope or dispense medication. Fluid can be supplied, and fluid and ablation material can be aspirated from the surgical site.

  Similarly, it will be appreciated that in certain embodiments of the present invention, a manually driven ablation accessory such as pliers may be provided with the cleaning and suction elements of the present invention.

  Furthermore, in all forms of the invention, the irrigation fluid need not always be delivered to the surgical site through an annular path between the outer housing and the rotating shaft. In one form of the invention, it is desirable for the ablation accessory to include a lumen with an annular cross section parallel to the path formed by the axis of rotation. This lumen is constituted by an auxiliary tubular structure integrated with the outer housing. Cleaning fluid is supplied through this lumen to the surgical site.

  Similarly, all handpieces incorporated into the system of the present invention and used in the method of the present invention should be in communication with the cleaning fluid supply line and the cutting accessory as soon as the cutting accessory is attached to the handpiece. It does not have to be designed. In another form of the invention, the surgeon may make this communication manually. Further, another handpiece of the present invention may not include an electric drive motor. In another form of the invention, the handpiece includes a pneumatic drive motor.

  The systems and methods of the present invention can also be used in different types of surgery than nasal, sinus or throat surgery. There may be other surgical procedures performed on a dry surgical site, i.e., a surgical site immersed in a cleaning solution enhanced in efficiency by the systems and methods of the present invention. Another type of surgery in which the systems and methods of the present invention are used includes laryngotracheal and vocal cord surgery. The system and method of the present invention are also used in plastic surgery and cosmetic surgery.

  Furthermore, in another form of the invention, additional components can be provided. For example, a flow meter may be attached to both the line 46 where cleaning fluid is supplied to the handpiece 24 and the line 139 that removes this fluid and debris by suction. In these forms of the invention, the flow rate through these tubes is monitored. The control console can also issue a warning alarm if the flow rate comparison reveals that the surgical site discharge flow rate is greater than the retraction. This alarm will allow the surgeon to recognize that the suction path may have been disturbed due to the difference in flow rate.

  Furthermore, the drugs and auxiliary compounds introduced into the surgical site by the method of the present invention are in a liquid state. In another embodiment of the present invention, the floating dry compound can be introduced by mixing the compounds in the cleaning liquid.

  Thus, it is the object of the appended claims to protect all variations and modifications within the spirit and scope of the present invention.

  The system and method of the present invention provide a number of advantages of increasing the efficiency of nasal passages, nasal cavities, and throat surgeries made in the lining of the nose. Can be released to the site. As a result, it is possible to easily remove tissue quickly while reducing the extent to which excess tissue is removed. The system and method of the present invention provides a means for a surgeon to clean an endoscope used for surgery without having to pull the endoscope out of the surgical site or further introduce additional instruments into a narrow surgical area. It is.

1 is an overall view of components of a surgical system according to the present invention. FIG. 2 shows the basic elements of a resection accessory of a surgical system according to the present invention. FIG. 3 is a cross-sectional view of the cutting accessory of FIG. 2. FIG. 6 is a perspective view of an outer hub of a cutting accessory according to the present invention. FIG. 6 is a cross-sectional view of an outer hub of a cutting accessory according to the present invention. It is sectional drawing of the far end of the rotating shaft of a cutting accessory. FIG. 6 is a rear view of the distal end of the rotation axis of the cutting accessory according to the present invention. FIG. 6 is a perspective view of an inner hub of a cutting accessory according to the present invention. FIG. 4 is a cross-sectional view of an inner hub of a cutting accessory according to the present invention. It is the front view which looked at the surgical handpiece by this invention to the near side. It is sectional drawing of the handpiece by the 8B-8B line | wire of FIG. 8A. It is sectional drawing of the handpiece by the 8C-8C line | wire of FIG. 8A. FIG. 3 shows how the resection accessory of the surgical instrument system of the present invention is used in surgery. FIG. 10 is a cross-sectional view taken along line 10-10 of FIG. 9 showing fluid flow between the ablation accessory and the tissue to which the ablation accessory is applied. FIG. 5 shows the means by which water is released from the distal end of the ablation accessory. FIG. 6 shows how debris is removed from the distal end of the endoscope using the surgical system excision accessory of the present invention. FIG. 6 shows a first means by which a piece of water is released from the distal end of the ablation accessory. FIG. 9 shows a second means by which a piece of water is released from the distal end of the ablation accessory. It is a block diagram which shows how the apparatus which supplies a chemical | medical agent to a surgery site | part was provided in the surgical system of this invention.

Explanation of symbols

20 Surgical System 24 Handpiece 26 Resection Accessory 32 Endoscope 36 Monitor 42 Supply Container 44 Pump 46 Supply Tube 137 Suction Pump 139 Suction Line

Claims (20)

A resection accessory configured to attach to a power-driven surgical handpiece,
The ablation accessory includes an outer hub such that the surface shape of the outer hub engages with a coupling assembly integral with the surgical handpiece such that the coupling assembly holds the outer hub to the handpiece. This outer hub is provided with a through-bore extending in the axial direction with a plurality of parts, one part of which is a storage part, and a housing part is provided in front of the storage part, The outer hub is further provided to form an inlet bore that extends from the outer surface to the through-bore side and opens to the through-bore between the storage portion and the housing portion,
In the cutting accessory, the outer housing is fixed to the through-bore housing portion of the outer hub, and the proximal end of the outer housing portion is disposed in the through-bore so as to be located in front of the inlet bore. An inner hub at least a part of which is disposed at a vicinity of the through-bore of the outer hub, and a distal end of the inner hub is disposed in a storage portion of the through-bore of the outer hub. The inner hub and the motor in the surgical handpiece are molded and provided to have a surface shape that easily couples, the inner hub is provided with a through bore,
A rotating shaft extending forward from the inner hub through the through-bore of the outer hub is provided, and the vicinity of the rotating shaft is seated on the through-hole of the inner hub,
An expandable O-ring fitted into the rotating shaft is provided near the far end of the inner hub so as to be positioned in the storage portion of the through-bore of the outer hub, and the inner diameter of the O-ring is the rotating shaft when not extending. The power-driven surgical apparatus is characterized in that the outer diameter is smaller than the outer diameter of the outer hub, and the outer diameter is larger than the diameter of the storage portion of the through-bore of the outer hub in the extended state. A cutting accessory configured to attach to the handpiece.   2. The rotating shaft according to claim 1, wherein the rotation shaft has a closed distal end and is formed to have a window in the vicinity of the distal end, and the window is defined by an end face constituting the cutting member. Resection accessory.   The resection accessory according to claim 2, wherein the rotation shaft is further formed to have a flat surface facing the window. Placing the endoscope in a dry passage, the step of placing the distal end of the endoscope so that the surgical site in the passage can be observed through the distal end of the endoscope;
Placing an elongated ablation accessory in the passage, the distal end of the ablation accessory being provided with a tissue processing member, the ablation accessory defining a path through which fluid is discharged from the distal end of the ablation accessory Said step comprising:
Observing the surgical site and excision accessory with an endoscope, using the excision accessory at the surgical site and performing an operation with the excision accessory;
Creating fluid flow so that fluid is ejected in a spray from the distal end of the ablation accessory, and the fluid spray discharged from the ablation accessory while the distal end of the endoscope remains in the passageway Cleaning the distal end of the endoscope by positioning the endoscope and resection accessory so that
And aspirating through a resection accessory to remove fluid released to clean the endoscope from the passage.   5. The method of claim 4, wherein the passage for inserting an endoscope and ablation accessory is one of the group consisting of a sinus passage, a nasal passage, and a throat. The ablation accessory has a movable shaft disposed within the outer housing;
The step of performing the treatment includes a step of moving the movable shaft with reference to an outer housing,
5. The method of claim 4, wherein the step of generating fluid flow is performed by discharging fluid through an outer housing in a gap space between the movable shaft and the cutting accessory. The power-driven surgical handpiece includes a motor and a movable shaft connected to the motor,
The method of claim 6, wherein the step of moving the shaft is performed by driving the handpiece motor. The ablation accessory has a tubular movable shaft disposed within the outer housing;
Performing the treatment comprises moving the tubular shaft;
The step of generating the fluid flow is performed by discharging the fluid through an outer housing in a gap space between the movable shaft and the cutting accessory,
The method according to claim 4, wherein the sucking step is performed by sucking through the moving tubular shaft.   9. The method of claim 8, wherein performing the surgical procedure is performed by rotating the tubular shaft. Placing an ablation accessory in the sinus passage, in the nasal passage or in the throat, the ablation accessory comprising an elongated outer housing having opposed proximal and distal ends with an inlet bore at the proximal end An exit opening is provided at the far end, an elongated tubular movable shaft having a far end and a near end facing each other is provided on the outer shaft, and a tissue processing member is attached to the opening near the far end and the far end. Said step;
Performing a surgical procedure using a resection accessory at the surgical site, wherein the distal end of the outer housing and the tissue processing member are directed to the tissue side of the surgical site;
Aspirating through the movable shaft from the distal end of the movable shaft simultaneously with the driving of the movable shaft so that the cleaning liquid is sucked through the distal end of the movable shaft when using an ablation accessory at the surgical site;
Driving the movable shaft to perform a surgical procedure on the tissue to which the resection accessory is directed;
Simultaneously with the driving of the movable shaft, the cleaning liquid flows into the outer housing through an inlet bore of the outer housing and a gap space between the outer housing of the cutting accessory and the movable shaft, Said step of flowing the outer housing at a flow rate of 25 milliliters or more per minute;
Providing a seal between the outer housing and the movable shaft, wherein the seal is 90% or more of the fluid introduced into the gap space between the outer housing and the movable shaft by the sealing; Is positioned between the outer housing inlet bore and the proximal end of the movable shaft so as to prevent the fluid from flowing out to the proximal end of the movable shaft, and the flow rate and suction of the cleaning liquid flowing into the outer housing inlet bore And the step of setting the sinusoidal volume so that 6% or more of the fluid flowing into the outer housing inlet bore is discharged from the outer housing outlet opening to the surgical site. Surgery in the sinus passage, nasal passage or throat.   The method according to claim 10, wherein in the step of driving the movable shaft, the movable shaft is rotated with respect to the outer housing.   The excision accessory is mounted on a handpiece having a suction passage in fluid communication with a proximal end of the movable shaft, and the suction step through the movable shaft is performed through the suction passage of the handpiece. The method according to claim 10. Further introducing an auxiliary compound into the cleaning solution prior to flowing the cleaning solution through the outer housing inlet bore of the ablation accessory;
13. The method of claim 12, further comprising the step of applying a release to the tissue from the ablation accessory window such that a mixture of cleaning fluid and auxiliary compound is applied to the tissue.   The flow rate of the cleaning fluid flowing into the outer housing inlet bore and the suction amount at which suction is performed are set so that 10% or more of the fluid flowing into the outer housing inlet bore is discharged from the outer housing outlet opening to the surgical site. The method according to claim 10.   The flow rate of the cleaning fluid flowing into the outer housing inlet bore and the amount of suction to be drawn are set so that the fluid flowing into the outer housing inlet bore is discharged from the outer housing outlet opening to the surgical site at a flow rate of 2 ml / min. 11. The method of claim 10, wherein: The outer housing is formed such that its distal end is closed, and the outlet opening is located near the distal end of the outer housing;
In the step of driving the movable shaft, the movable shaft rotates, and the outer surface of the movable shaft is selectively positioned so as to be aligned with the outer housing outlet opening in the driving step of the movable shaft. Formed to have the above flat surface,
In the cleaning liquid flow step through the outer housing, the cleaning liquid covers the flat surface of the movable shaft so that the cleaning liquid is pulsed from the outlet opening when the flat surface is aligned with the outlet opening of the outer housing. The method of claim 10, wherein the method flows.   17. The method of claim 16, wherein in the cleaning liquid discharge step through the outer housing opening, the cleaning liquid is discharged to the near side away from the distal end of the outer housing.   11. The method of claim 10, wherein up to 20% of the wash fluid entering the outer housing inlet bore is discharged from the outer housing outlet opening to a surgical site. Placing an ablation accessory in the sinus passage, in the nasal passage or in the throat, the ablation accessory comprising an elongated outer housing having opposed proximal and distal ends with an inlet bore at the proximal end Provided with an outlet opening at the far end, an elongated tubular movable shaft having a facing far end and a near end on the outer shaft, and a tissue processing member attached to the opening near the far end and the far end Said step;
Performing a surgical procedure using an ablation accessory at the surgical site, wherein the distal end of the outer housing and the tissue processing member are directed to the tissue side of the surgical site and the tissue to which the ablation accessory is directed Driving the movable shaft to perform the surgical procedure of:
Generating a mixture of local drug and cleaning fluid;
Simultaneously with driving the movable shaft, flowing the mixture into the outer housing through an outer housing inlet bore and a clearance space between the outer housing of the cutting accessory and the movable shaft;
Expelling the mixture from the distal end opening of the outer housing such that the mixture is expelled to tissue that is operated upon by the ablation accessory simultaneously with actuation of the ablation accessory;
And a step of sucking through the movable shaft simultaneously with the operation of the cutting accessory so that fluid is sucked through the opening on the distal end of the movable shaft when the cutting accessory is used at a surgical site. Surgery in the sinus passage, nasal passage or throat.   The step of generating a mixture of the local drug and cleaning liquid and the step of flowing the mixture through the outer housing inlet bore include pumping the cleaning liquid from the source to the outer housing inlet bore, and pumping the cleaning liquid from the source. 20. The method of claim 19, further comprising the step of introducing a local agent into the cleaning liquid pumped from the source to form a mixture.

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